A Republican president probably wouldn’t repeal Obamacare

Mother Jones blogger Kevin Drum is undergoing treatment for cancer. So he takes seriously Republican threats to repeal Obamacare if they win in 2016:

“This is more personal for me than usual. Scary, too. There are no guarantees in life, and there’s no guarantee that MoJo will employ me forever. If I lose my job, and Republicans repeal Obamacare, I will be left with a very serious and very expensive medical condition and no insurance to pay for it. And I feel quite certain that Republicans will do nothing to help me out.

“Obviously lots of other people are in the same position, and have been for a long time. But there’s nothing like being in the crosshairs yourself to bring it all home. If Republicans win in 2016, my life is likely to take a very hard, very personal turn for the worse.”

But this is also why repeal won’t be viable, even if Republicans have the votes to do it in 2017.

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It’s one thing to blame everything on Obamacare. The law isn’t designed to advertise its benefits, and people who have difficulties with health care will find it easy to blame the last big (highly controversial) reform. We still have no polling to confirm it, but I suspect that a shrinking minority of the millions who’ve become insured thanks to the law are even aware that “Obamacare” is the cause.

As Jonathan Chait describes the Republican health plan, it would “repeal all of Obamacare, replace its savings with $1 trillion in magic money, and then spend zero on subsidizing health insurance for the millions of Americans who would become uninsured.”

Other than hard-core partisan Republicans, no one would blame Obama if their insurance disappeared under President Scott Walker and a Republican Congress. Indeed, the dynamic would flip: Republicans would suddenly be blamed for every health-care policy problem, whether it was caused by repeal or not.

Even a successful replacement plan wouldn’t shield Republicans from blame – all legislation requires trade-offs, and most of the time the losers care more than the winners. But passing a successful replacement for Obamacare would be extraordinarily difficult.

Drum himself is an excellent example of the problem. A highly informed and liberal blogger, he’s unusually aware of how government policies affect his health care, so that’s atypical. But as a middle-class professional, he’s exactly the kind of citizen who votes reliably and sometimes engages more directly in politics. In sum, he’s the type of person elected officials prefer not to upset.

The crass truth: Cuts to Medicaid or other programs are resisted in large part because many middle-class and wealthier voters don’t want to hurt the poor. Their compassion is powerful enough to keep those programs going. But compassion can’t compare with their naked self-interest, which would be on the line in any Obamacare repeal.

I’d say there’s a 5 percent chance or so that Republicans –if they have the votes in 2017 – would just repeal Obamacare. Repeal and replace also has about a 5 percent shot. Much more likely would be relatively small, targeted cuts to benefits for the poorest, coupled with repeal of the tax increases that fund those benefits.

And the most likely outcome? A total fudge. Either Republicans would “repeal” the ACA but keep it up and running until a genuine Republican replacement was finally ready, or they would “repeal” it and replace it with a virtual copy, albeit one blessed by a liberal (sorry) sprinkling of “liberty” and “free enterprise” and “Ronald Reagan” throughout the text.

In other words, under Republican government there’s a good chance that health care subsidies would become less generous, Medicaid would grow more stingy and the fiscal situation would deteriorate badly. But repeal? Only if Republican politicians are even more trapped in their information bubble than I suspect.

Jonathan Bernstein is a Bloomberg View columnist covering U.S. politics.